Provider Demographics
NPI:1720846058
Name:WASSERMAN, ABRAHAM (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:ABRAHAM
Middle Name:
Last Name:WASSERMAN
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1830 WRIGLEY ST APT 8
Mailing Address - Street 2:
Mailing Address - City:ELY
Mailing Address - State:IA
Mailing Address - Zip Code:52227-9688
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1830 WRIGLEY ST APT 8
Practice Address - Street 2:
Practice Address - City:ELY
Practice Address - State:IA
Practice Address - Zip Code:52227-9688
Practice Address - Country:US
Practice Address - Phone:845-327-6732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-11
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAG178551363LP0808X
TN36162363LP0808X
AZ305418363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health